What you should know
1. The age requirement for Medicare is 65 unless you’re entitled to disability benefits or have permanent kidney failure. 2. If you don’t qualify for premium-free Part A, you can pay a premium to get it.
3. You must have Parts A and B to opt for Medicare Advantage (Part C), Part D, or a Medicare supplement (Medigap). 4. You can use Medicare’s eligibility tool to determine whether you qualify for coverage.

Medicare, the federal health insurance program, is available to people 65 and older and younger people who live with qualifying disabilities. To qualify for Medicare, you must be 65 and a United States citizen or lawful permanent resident, unless you’re entitled to receive Social Security retirement benefits, U.S. Railroad Retirement Board (RRB) benefits, or Social Security Disability Insurance (SSDI).

Medicare has four distinct parts:

  • Part A: Hospital insurance, which helps cover hospital inpatient stays, skilled nursing facility care, hospice, and home health services
  • Part B: Medical insurance which helps cover outpatient doctor visits, durable medical equipment, and some preventive services
  • Part C: Medicare Advantage, which bundles together Parts A, B, and usually D
  • Part D: Drug coverage, which helps cover the cost of prescription drugs

You must have Parts A and B to opt for a Medicare Advantage Plan (Part C), Part D, or a Medicare supplement (Medigap).

Who qualifies for Medicare?

The age requirement for Medicare is 65 unless you’re entitled to disability benefits or have permanent kidney failure. In the case of disability or permanent kidney failure, the age requirement of 65 is not enforced, but restrictions and timeframes apply.

Most people who qualify for Medicare don’t have to pay a premium for Part A because they have worked at least 10 years (40 quarters) and paid Medicare taxes or have worked for the railroad or in a civil service job.

If you’re 65 or older, you can receive Medicare Part A benefits premium-free under any of these circumstances:

  • You’re receiving or are eligible to receive retirement benefits from Social Security or the RRB
  • Your spouse ― living or deceased, including divorced spouses ― receives or is eligible to receive Social Security or RRB benefits
  • You or your spouse worked long enough in a government job through which you paid Medicare taxes
  • You’re the dependent parent of a fully insured deceased child

If you’re younger than 65, you can receive Medicare Part A premium-free under any of these circumstances:

  • You have been entitled to Social Security or RRB disability benefits for 24 months
  • You have Lou Gehrig’s disease (amyotrophic lateral sclerosis, or ALS); in this case, there’s no waiting period, and your Medicare benefits begin the first month you get disability benefits
  • You worked long enough in a government job through which you paid Medicare taxes, and you’ve met the requirements of the Social Security disability program for 24 months
  • You’re the child or widow(er) age 50 or older, including a divorced widow(er), of a worker who has worked long enough under Social Security or in a Medicare-covered government job, and you meet the requirements of the Social Security disability program
  • You have permanent kidney failure ― end-stage renal disease or (ESRD) ― and you receive maintenance dialysis or a kidney transplant and one of the following applies:
    • You’re eligible for or receive monthly benefits under Social Security or the railroad retirement system
    • You’ve worked long enough in a Medicare-covered government job
    • You’re the child or spouse, including a divorced spouse, of a worker ― living or deceased ― who has worked long enough under Social Security or in a Medicare-covered government job

Is there a way to get Medicare if you don’t qualify for free?

If you don’t qualify for premium-free Part A, you can buy Medicare Part A by paying premiums if you are 65 or older and a U.S. citizen/permanent resident.

You’ll pay a premium of either $259 or up to $471 each month in 2021 depending on how long you or your spouse worked and paid Medicare taxes. If you or your spouse paid Medicare taxes for 30 to 39 quarters, your Part A monthly premium will be $259. If you or your spouse paid Medicare taxes for less than 30 quarters, your premium will be $471 per month.

If you’re paying premiums for Part A, and if you continue to work and pay Medicare taxes, those quarters will count toward your total number of quarters worked. Your premiums for Part A will be free once you work 40 total quarters.

In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. If you choose not to buy Part A, you can still buy Part B. Whether you pay Part A premiums or not, and regardless of whether or not you opt for Original Medicare Parts A and B, or a Medicare Advantage or Medigap plan, you’ll always pay a Part B premium.

You can receive help paying for premiums if you qualify for a Medicare Savings Program if your income and resources are below a certain limit. To find out if you’re eligible for Medicare and your expected premium go to the Medicare eligibility tool.

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Leron Moore
Medicare consultant

LeRon Moore has guided Medicare beneficiaries and their families as a Medicare professional since 2007. First as a Medicare provider enrollment specialist and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.

Moore holds a bachelor’s degree from Southern New Hampshire University and is A+ Certified with a Medical Records Clerk Certification and Medical Terminology Certification from Midlands Technical College.

He’s passionate about educating, informing, and resolving issues concerning Medicare and Medicare Advantage Plans, and considers it imperative that he does all he can to educate and inform the senior community as much as possible about Medicare.

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